This document discusses the classification and approach to osteomyelitis (OM). It notes that OM is becoming more common due to secondary causes like surgery, injury, and diabetes. The document outlines the differences between acute and chronic OM, signs and symptoms to look for, common locations, and characteristics of each type. It recommends investigations and cultures if OM is suspected. The key classification discussed is the Cierny-Mader system, which considers the physiological health of the patient and the anatomical location and spread of the infected bone to determine the appropriate treatment approach.

1. Approach &
Classification of OM

2. Intro
O Osteomyelitis getting more common
O Pattern changing
O Lesser– Haematogenous origin
O More common – 2o to surgery, injury, DM
O Potential outcome
O Acute OM – major systemic illness –
mortality
O Chronic OM – chronic pain and ill health
– unemployment, recurrent
medical treatment

3. When to suspect?
Oh/o systemic
infection (esp
paeds)
Oh/o surgical
intervention /
trauma
Bony tenderness

4. When to suspect?
O Signs & symptoms of infection

5. When to suspect?
O Signs & symptoms of infection

6. When to suspect?
O Signs & symptoms of infection

7. Acute (H) OM
O Pre pubertal children /
elderly
O Rapid onset of pain,
fever, malaise
O Signs of bacterimia in
>50%
O Rarely have sinus or
other skin signs
O May also present as
septic arthritis

8. Acute (H) OM
O Haemategenous
spread
O Common at
metaphysis of leg
bone:
O Distal femur
O Proximal tibia

9. Chronic OM
O H/O trauma / surgery /
implant insertion
O Early – difficult to
identify
O Established – sinus or
its scars, abscess, skin
changes, deformed
and atrophied limb

10. Chronic OM
O Presence of dead
bone
O Classical features:
O Sequestrum
O Involucrum
O Cloacae
O Sinus

11. What to do next?
O When history and PE gives a strong
suggestion of OM as a diagnosis:
O Lab investigations
O Radiographic investigations

12. Gold standard
O Culture from > 1 deep
specimen tissue
culture
O Taken with strict
aseptic technique
O In pt NOT on
antimicrobial therapy
for at least 10 days

13. CLASSIFICATION

14. General
O Many classifications based on type and
origin
O Doesn’t help in m(x)
O Classification that guides management:
O Cierny-Mader classification

15. Cierny-Mader
O Physiological grouping of host
O Important to determine pt’s ability to cope
with prolonged treatment
O Highlight pt’s area of dysfunction that could
be optimized for better healing
O Anatomical type of the disease
O Based on specific distribution of infected
bone

16. Physiological group
O A – healthy host
O B – host with impairments that directly
affect ability to heal / reduce efficacy of
drugs / prevent surgery
O Bl – local conditions
O Bs – systemic conditions
O Bls – both
O C – moribund pt
O Treatment of infxn does not improve
survival or QOL

17. Physiological group

18. Anatomical type

19. Medullary

20. Superficial

21. Localized

22. Diffused
Main difference from type
III:
- The stability of bone is
affected